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PLUMBING PERMIT, IYPE: FIRELINE/SPRINKLER

APPLICATION DATE PERMIT NO,

This permit is issued to the Owner/Agent named below, for the purpose of
the plumbing: or related work described herein. The validity of this
permit is subject to compliance with the plans and other documents
submitted with the permit application, and to the compliance with the
"Budlding and Plumbing Bylaw".

DESCRIPTION OF WORK

ADDRESS

LO?

COSTRAGKOR

Name

Address Address

City City

Postal Code Telephone Portal Cade Telephone

SIGNATURE OF NAME
OWNER/AGENT TELEPHONE

NOTES

PERMIT FEES:

Fire Hydrant(s) Fire Hydrant(s)
Fireline Metres of Line
Sprinkler Head(s) Head(s)

Siamese Con. Connection(s)
Hose Cabinet(s) Cabinet (s)

Hose Outlet(a) Outlet(s)
Wet/Dry Outlet(s) Outiet(s)
Standpipe(s) Standpipe(s)
Special Inspect. No. of Inspect.
Other Specify

TOTAL FEES:

THE ISSUANCE OF THIS PERMIT SHALL IN NO CASE BE ‘TAKEN AS ASSUMPTION OF
RESPONSIBILITY BY THE CITY FOR ERRORS OR VIOLATIONS Of CODES, STATUTES OR

BYLAWS

BUILDING _ DATE...
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